Application for Permission to Employ Actors & Stage Managers Under the Special Appearance AgreementComplete and submit to the appropriate Equity office at least 3 weeks prior to the 1st rehearsal date. Select Applicable Agreement Type:

Application Date: STANDARD STANDARD BUFFALO/ROCHESTER PITTSBURGH LEVEL I LEVEL II I II III IV I II III

A. EMPLOYER INFORMATION

Phone: Fax:

Producing Organization:

Address:

City: State: Zip:

501.C.3. Non-Profit? Yes No If yes, registration #.

Has your organization utilized other Equity contracts? Yes No If yes, which one(s)?:

Will salary be paid via: Producing Organization’s Payroll Paymaster? If Paymaster, list name, phone # & address below:

Paymaster’s Name: Phone:

Paymaster’s Address:

The information for following three items should refer to the organization issuing salary payments & deductions (either Producer or Paymaster)

Federal ID #:

Unemployment Insurance Registration Number : State:

Workers’ Compensation Carrier: Policy #:

Title:

Email:

Zip: Phone: Fax:

Theatre Company Contact Person:

Address:

City: State:

Name of Producer Authorized to Sign Contract(s):

AEA Member? Yes No Phone: Fax: Email:

B. PRODUCTION INFORMATION

Type: Drama Musical Revue Show Title:

1st Rehearsal Date:

# of Rehearsal Weeks:

1st Performance Date:

# of Performance Weeks:

Closing Date:

# of Performances per week (Mon-Sun):

High, Low Ticket Price: Avg Ticket Price: Total Weekly Potential B.O.:

Theatre Facility: Stage Name:

Address: City: State: Zip:

Box Office Phone #: Backstage Phone #: Seating Capacity:

Seating: Fixed Flexible Stage: Proscenium Thrust Black Box Outdoor Other:

AEA Special Appearance Agreement Application Form (Rev 4/03) Page 1 of 4

Producer to Pay for Expanded Media: Yes No

C. ACTOR & STAGE MANAGER INFORMATION

Producer to pay Health Plan Contributions? Yes No

NOTE: If Health Plan Contributions are made, they must be made for ALL Equity members employed under this Agreement for this Production. Contact Equity for current weekly Health Plan contribution rates. SWC Insurance premiums and Pension Plan contributions remain mandatory.

Actor Name: Member ID #:

Mailing Address:

Zip: City:

Role:

State:

Weekly Rehearsal Salary:

Date of 1st Performance:

Phone:

Weekly Performance Salary:

Closing Date: Date of 1st Rehearsal:

Housing Required? Yes No Per Diem:

Other Contractual Considerations (Housing, Use of Car, Overlap periods, etc.):

Actor Name: Member ID #:

Zip: State:

Weekly Rehearsal Salary:

Date of 1st Performance:

Phone:

Weekly Performance Salary:

Closing Date:

Mailing Address:

City:

Role:

Date of 1st Rehearsal:

Housing Required? Yes No Per Diem:

Other Contractual Considerations (Housing, Use of Car, Overlap periods, etc.):

Actor Name: Member ID #:

Mailing Address:

Zip: City:

Role:

State:

Weekly Rehearsal Salary:

Date of 1st Performance:

Phone:

Weekly Performance Salary:

Closing Date: Date of 1st Rehearsal:

Housing Required? Yes No Per Diem:

Other Contractual Considerations (Housing, Use of Car, Overlap periods, etc.):

Member ID #:

State: Zip: Phone:

Weekly Performance Salary:

Closing Date:

Mailing Address:

City:

Weekly Rehearsal Salary:

Pre-Prod. Start Date:

Housing Required?

Stage Manager Name:

Yes

Date of 1st Reh.:

No

Date of 1st Perf.:

Per Diem:

Other Contractual Considerations (Housing, Use of Car, Overlap periods, etc.):

PLEASE NOTE: This Application Form DOES NOT constitute a contract.

No Equity Actor or Stage Manager may begin rehearsals without having signed an Equity contract. Do NOT send checks until your application has been processed, approved, and you receive a permission letter.

Consult either Applying for Special Appearances or the Special Appearance Agreement Terms, Conditions and Work Rules (both available online at Equity’s website: www.actorsequity.org) or contact your regional Equity Business Representative for more information.

AEA Special Appearance Agreement Application Form (Rev 4/03) Page 2 of 4

http:www.actorsequity.org

APPLYING FOR SPECIAL APPEARANCES: A LINE-BY-LINE GUIDE TO THE APPLICATION FORM

A. EMPLOYER INFORMATION

PRODUCING ORGANIZATION CONTACT INFORMATION Organizations that maintain P.O. Box mailing addresses should also include a street address for express deliveries.

PAYMASTERS & INSURANCE INFORMATION All Producers must provide two basic forms of insurance coverage under the Special Appearance Agreement: Unemployment Insurance and Worker’s Compensation Insurance. The Unemployment Insurance benefits must be those provided by the Unemployment Insurance Laws of the state in which the Actor performs. If the theatre is exempt from paying this insurance by state law, the theatre must elect to pay either voluntary coverage in accordance with the New York or New Jersey State Unemployment Laws or use the services of a paymaster who can provide this benefit. Similarly, Worker's Compensation Insurance coverage must be obtained and maintained for all Equity members in the Producer's employ and may not be waived; without such coverage, permission to use the Special Appearance Agreement will be denied. A weekly premium payment for Supplemental Worker’s Compensation Insurance to extend standard coverage is also required and must be paid IN ADDITION TO standard Worker’s Compensation Insurance.

About Paymasters: Paymasters can supply three essential services required by the Special Appearance Agreement:

- They can provide the production with both Workers’ Compensation Insurance coverage as well as Unemployment Insurancecoverage;

- They will process the payroll for the production, including calculation and withholding of taxes listed on a statementaccompanying payroll checks (and they will send W-4 ax forms at year’s end);

- They will issue pension/health and dues payments to Equity, as well as the final two weeks’ paychecks required in lieu ofbond; all payments issued by a paymaster are considered equal to certified/cashier’s checks or money orders sincepaymasters require payment in advance. Payroll services (for example, ADP or Paychex) are not paymasters.

Paymasters function as the “Employer of Record.” If a paymaster is used, then the paymaster’s Federal ID number must be entered onto the application form, as well as the insurance policy numbers and carrier names held by the paymaster.

Conflict of Interest If the person signing the contracts for the theatre company is a member of Equity, that member is an “Employer-Member” and subject to the provisions of Article VI (“Conflict of Interest”) of the Equity Constitution and By-Laws. The provisions restrict the Employer-Member from attending any AEA meetings. All other membership benefits (such as voting rights and pension and health benefits) are NOT affected by Article VI provisions.

B. PRODUCTION INFORMATION

PRODUCTION/SHOW INFORMATION: Name of Play, Role, Production Dates & “Work Weeks” The Equity work week runs Monday thorough Sunday, with no allowance for pro-rated weeks. This means that if the date of first rehearsal lands on a Sunday, that one day of rehearsal will be regarded as an entire workweek. Therefore, careful scheduling is strongly advised.

TICKET PRICING & WEEKLY POTENTIAL BOX OFFICE GROSS INCOME (WPBO) Together with the size of theatre and the number of weekly performances, the Weekly Potential Box Office (WPBO) figure determines if the production qualifies for either of the two categories of Special Appearance Agreement. This figure is the MAXIMUM INCOME POSSIBLE if every seat was sold at its pre-assigned face value.

Formula: $ [average ticket price] X [total # of seats] X [# of performances per week] = $ [WPBO]

METHODOLOGY: The Average ticket price is the average of different prices that vary because of schedule or location. For example, if Friday and Saturday tickets cost $20.00 and the same number of seats on Wednesday and Thursday cost $10.00, then the Average is $15.00. If no Wednesday performance occurs, the average would become $16.66 since the average would include fewer $10.00 tickets. By similar calculations, balcony or other "off-price" locations can be averaged, although this is unusual in small theatres. Discounts such as Student discounts or Senior Citizen discounts are not part of calculations since the number sold at such discounts is unknown in advance.

THEATRE INFORMATION, TICKET PRICING & PERFORMANCE SCHEDULE The theatre’s street address is used to send the final two weeks’ salary (held by the Union as a guarantee in lieu of bond) to “out-of-town” Actors unless otherwise noted. Equity will send these payments to the theatre rather than the out-of-town Actors’ permanent residence to guarantee the Actor can deposit or cash the payment.

Applying for Special Appearances: A Line-by-Line Guide to the Application Form (rev. 10/12) Page 1 of 2

C. ACTOR & STAGE MANAGER INFORMATION: Address, Salary & Benefits

Health Benefits Under all other salaried Equity agreements, health contributions are required by the contract. The Special Appearance Agreement does not require health contributions. However, in the event Producer elects to provide health plan credits, payments must be made for EVERY Equity Member so employed. Please note that while health benefits are not required, it is still necessary for the theatre to contribute to Supplemental Worker’s Compensation insurance coverage for each Actor in its employ (see the instructions for Paymasters & Insurance Information).

Salary Although Equity establishes minimum salaries, Actors and employers are encouraged to negotiate above such minimums whenever possible. Current minimums are listed in the Special Appearance Work Rules.

Housing & Travel (Per Diem) If Actors or Stage Managers will not be living at their home addresses, or if Actors live 50 or more miles away from the theatre, the theatres must provide the Actors with FREE housing and a per diem (daily out-of-town expenses paid separately from salary; see Work Rules for minimums). Discussing this with the artist in order to ascertain the Member's tastes and needs will help ensure the best results. If local transportation is necessary from the lodging to the theatre, the theatre must provide this transportation at no cost to the actor.

The theatre must also provide out-of-town Actors round-trip transportation in the form of an airline or railroad ticket or cash at least three days in advance of the Actor's departure for the place of engagement. All transportation costs, including but not limited to taxis, baggage handling and gratuities, must be paid.

Other Contractual Considerations In this section, list any additional compensation package provisions. If applicable, any overlap period between productions (and resulting additional salary increment) should also be noted here. Refer to the applicable regional work rules or contact a regional Equity Business Representative for further information.

APPLICATIONS & CORRESPONDENCE MUST BE SENT TO THE APPROPRIATE REGIONAL EQUITY OFFICE:

Eastern Region Central Region Western Region

AL, CT, DC, DE, FL, GA, ME, MA, MS, NH, NJ, NY, NC, PA, RI, SC, TN, VT, VA

AK, IL, IN, IA, KS, KY, LA, MI, MN, MO, NE, ND, OH, OK, SD, WI

AK, AZ, CA, CO, HI, ID, MT, NV, NM, OR, TX, UT, WA, WY

Actors' Equity Association Attn: Special Appearances

165 W 46th Street New York, NY 10036

212-869-8530

Actors' Equity Association Attn: Special Appearances

557 West Randolph St Chicago, IL 60661

312-641-0393

Actors' Equity Association Attn: Special Appearances

5636 Tujunga Ave North Hollywood, CA 91601

323-978-8080

For more information, please refer to the Special Appearance page of the Equity Website (www.actorsequity.org) or call your Regional Office.

AFTER APPROVAL: How to obtain contracts

Sending Payments: After the request has been processed by Actors' Equity Association, you will be notified if permission has been granted and all terms meet with Equity's approval. A letter stating such permission will also specify the following required material that must be sent to Equity in order for contracts to be sent for signature (Please note: the Special Appearance Application form is NOT a contract):

A. A certified check (or bank draft or money order) payable to the “EQUITY-LEAGUE PENSION AND HEALTH TRUST FUNDS” to coverthese contributions for the entire period of employment; and

B. Two (2) certified NET WEEKLY SALARY CHECKS or MONEY ORDERS in the amount of net weekly salary, payable to the Actor to beheld by Equity in lieu of salary bond, and subsequently sent to the Actor/SM by AEA.

C. A certified check (or bank draft or money order) payable to “ACTORS' EQUITY ASSOCIATION” to cover the member's dues obligation.D. Two (2) STATEMENTS OF DEDUCTIONS from the two (2) above-mentioned weekly salary checks.

Filing Contracts, Pension/Health Cards & Programs: Upon receipt of the four (4) checks sent to the attention of the appropriate Business Representative, Equity will forward the following material which should be filled out, properly executed, and immediately returned to Equity:

1. One (1) quadruplicate set of contracts. The Actor and Producer should each retain a copy and each separately file a copy with Equity.2. A Pension & Health enrollment card for each Actor. (This tracks both pension payments and health benefit plan contributions.)Additionally, please send Equity a copy of the program as soon as it is printed. REMEMBER: The Equity Actor(s) and Stage Manager must be properly credited in the cast list. An asterisk must follow his/her name with the explanation: “Appearing Courtesy of Actors’ Equity Association, the Union of Professional Actors and Stage Managers in the United States, appearing under a Special Appearance Contract.”

Applying for Special Appearances: A Line-by-Line Guide to the Application Form (rev. 10/12) Page 2 of 2

http:www.actorsequity.org

TOP FIVE QUESTIONS ABOUT THE SPECIAL APPEARANCE AGREEMENT

1. What is the Special Appearance Agreement?The Special Appearance Agreement was created as a way for Equity members to work with their localsmall community theatre groups, in areas beyond major market cities, on a case-by-case basis. TheAgreement provides a service for Equity members to occasionally pursue artistic opportunities outsidestandard professional situations (hence the term "Special Appearance"); it was not intended to be ameans of routine employment. Small theatre companies interested in the routine employment of Equitymembers should contact an Equity Business Representative to discuss use of a Small ProfessionalTheatre agreement instead or review other contractual options.

2. Who can use a Special Appearance Agreement?Equity Members in “good standing” (no unresolved membership issues, such as unpaid dues or fines)may seek to work with theatre companies falling within the following seating, income and schedulelimitations:

- Theatres of 99 seats or less with a total potential weekly box office gross income of $8,000 or less,scheduling no more than 4 performances per week

- Theatres of 199 seats or less with a total potential weekly box office gross income of $20,000 or less,scheduling no more than 5 performances per week

As long as the theatre company falls within these limitations and can satisfy prepayment and insurance coverage requirements, any theatre company may apply.

3. How many Equity members can be employed using the Special Appearance Agreement withinthe same production?A theatre company may apply on behalf of up to three (3) Equity members for permission to use theSpecial Appearance Agreement. In certain territories (the greater Pittsburgh, PA area and the Buffalo-Rochester area of NY), a theatre company may apply on behalf of more than three Equity members forpermissions, but such applications must include an Equity Stage Manager.

4. What are the application deadlines? How long does the application process take?The appropriate Equity regional office must receive applications no later than three (3) weeks prior to thedate of first rehearsal. It may take up to four (4) weeks to review applications after they are received, thenpossibly as long as another month to receive required payments and exchange contracts as describedwithin these Guidelines. As processing largely depends on prompt receipt of required payments, pleaseallow sufficient lead-time.

Please be advised that applications received less than three (3) weeks prior to the date of first rehearsal may be denied. In the event that a last-minute application is accepted, any necessary subsequent express delivery charges (e.g. USPS Express Mail, Federal Express, UPS, Airborne, etc.) must be prepaid by the theatre company.

5. How do I get started?Application forms, Work Rules, and a Line-by-Line Application Guide are available online atwww.actorsequity.org or by mail upon request from the nearest regional Equity office.

http:www.actorsequity.org

Special Appearance ApplicationApplication InstructionsTop Five Questions About Special Appearance

AppDate: EmpOrg: EmpOrgAddress: EmpOrgCity: EmpOrgState: EmpOrgZip: EmpOrgPhone: EmpOrgFax: NonProfitNumber: PreviousContracts_text: PaymasterName: PaymasterPhone: PaymasterAddress: FEIN: UnemploymentNumber: UnemploymentState: WorkersCompCarrier: WorkersCompPolicy: Contact: Title: ContactAddress: ContactEmail: ContactCity: ContactState: ContactZip: ContactPhone: ContactFax: SigAuthorization: SigPhone: SigFax: SigEmail: ShowTitle: FirstReh: FirstPerf: Closing: RehWks: PerfWks: WklyPerfs: HiLoTix: AvgTix: BO_Potential: TheatreFacility: StageName: TheatreAddress: TheatreCity: TheatreState: TheatreZip: BO_Phone: BackstagePhone: Capacity: Seating_Fixed: OffSeating_Flex: OffStage_Other: ActorName: ActorAddress: ActorCity: ActorState: ActorZip: ActorPhone: ActorRole: WklyRehSalary: WklyPerfSalary: ActorFirstReh: ActorFirstPerf: ActorClosing: ActorPerDiem: ActorOther: SMState: SMZip: SMPhone: SMWklyPerfSalary: SMPreProd: SMFirstReh: SMFirstPerf: SMClosing: SMPerDiem: SMOther: 501C3_Non-Profit: OffPreviousContract: OffSigAEAMember: OffShowType: OffProdHealth: OffMemberID1: Actor1Housing: OffActor2Housing: OffActor3Housing: OffSMHousing: OffAgreementType: OffSalaryOption: OffStageType: OffActorName2: MemberID2: ActorAddress2: ActorCity2: ActorRole2: ActorFirstReh2: ActorState2: ActorZip2: WklyRehSalary2: ActorFirstPerf2: ActorPerDiem2: ActorClosing2: WklyPerfSalary2: ActorPhone2: ActorOther2: ActorName3: ActorAddress3: MemberID3: ActorPhone3: WklyPerfSalary3: ActorClosing3: ActorPerDiem3: ActorZip3: ActorState3: WklyRehSalary3: ActorFirstPerf3: ActorCity3: ActorRole3: ActorFirstReh3: ActorOther3: SMName: SMAddress: MemberIDSM: SMCity: SMWklyRehSalary: ExpandedMedia: Off